Prolactinomas that coincide with concomitant psychotic disorders can prove a considerable challenge to treat. A number of dopaminergic drugs are the standard therapeutic treatment for prolactinoma, but their side-effects include aggravating psychotic symptoms. Meanwhile, patients with psychotic disorders are mostly treated with dopamine receptor D2 antagonists, which can increase prolactin levels.

Bakker et al. report on the case of a 30-year-old woman who presented with a 2-year history of headaches and amenorrhea. She also had a 6-year history of depressive symptoms. Further tests found an elevated prolactin level of 2.25IU/L and an 8mm pituitary microadenoma.

Following treatment with a series of dopaminergic drugs, the team struggled to balance the improvements in her pituitary disease with changes to her psychotic health. The patient was commenced on aripiprazole, a relatively novel antipsychotic drug, not associated with an increase in prolactin levels. Over a 10-year follow up, the authors report that use of this drug led to improved psychotic symptoms, normalised prolactin levels and a decrease in prolactinoma size. They conclude that aripiprazole can be a valuable pharmaceutical tool to treat both prolactinoma and psychosis.

Read the full article in Endocrinology, Diabetes & Metabolism Case Reports 6 EDM-16-0028 (OA)